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4 hours ago, blah1234 said:

I have friends that work or have worked in CHC. Although the pace is slow the patients can often be complex and difficult to deal with. Also, I believe that because of your salary you can't bill extra for things like paperwork, but I don't think that's a huge deal breaker. 

I think they get the HOOPP pension but I'm not sure of all the details. It should be something where the longer you work in that role the better your pension situation is. However, I don't think any of my friends have survived in the CHC system for long. 

Yes. In Ontario CHC physicians qualify for HOOPP pensions. You do have to be willing to spend the time with very complex patients, and really understand and GET the social determinants of health, or you will be frustrated and not enjoy CHC work. You can’t bill extra for paperwork (whether government-required paperwork, i.e. disability applications, or private paperwork, i.e. sick notes). I, personally, found CHC work to be much more rewarding than “standard” primary care work, because I was truly making a difference in my patients’ lives. Others, who are more focused on earning $ may not enjoy CHC work. Those who don’t want to deal with complex patients won’t enjoy CHC work. Those who don’t understand how adverse childhood experiences impact adult health won’t enjoy CHC work. Those who don’t believe in the fundamental influence of the social determinants of health won’t enjoy CHC work. Those who think they know better than allied health won’t enjoy CHC work. But for those who truly appreciate their allied health colleagues, who GET the social determinants of health at a fundamental level, who truly enjoy providing health care to populations who have traditionally been marginalized and/or ignored, then CHC work is incredibly rewarding.

I’ve moved into academia because I want to do research that will hopefully influence how we provide care (once you’ve been in the workforce for a while, you see the enormous gaps and want to figure out how we can improve things). If I hadn’t, I would have spent the rest of my career in CHCs. It’s incredibly rewarding to see a client through from assessment to discharge, and to actually make a real difference in their lives. There are super challenging clients, and sometimes you wonder why you are even there, but when you actually make a huge difference in someone’s life, then that makes all the no-shows and challenging clients worthwhile. When they are able to stop taking antihypertensives because their blood pressure is normal with just diet and exercise, or when they can manage their blood glucose levels with diet and exercise, you know you have made a difference. 

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5 hours ago, JohnGrisham said:

I find that most people don't actually understand how incorporation works and automatically assume that its a tax break by default. This isn't universally the case depending on your financial needs and how much you draw from your corporation.   

Hands down, i would take a pension over incorporation in most scenarios of equivalency. 

It's not a tax break by default, but if building a high net worth and a portfolio of assets is your main goal, then incorporating any business will do wonders - healthcare or not. If taking home a high salary and using it is your purpose, then I would rather have the pension, because you'll have to pay taxes on the money you take out of your corp either way, AFTER paying the corp tax 

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In the long run, if you've motivated to bill more - it's far easier to have a higher net income in a non-salaried position. There are just so many things you can bill for, in so many different microfields/niches that you'll be ahead. 

Now if you want to do basic bread and butter outpatient family medicine at a slow pace, then this may be ideal. 

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24 minutes ago, brady23 said:

Anyone know what the job market is like for CHC salaried physicians?

And most of the jobs would be clustered around downtown Toronto I'm assuming? 

Last I talked with my friends I heard that there are CHC spots that have difficulty filling. Not sure what the distribution of CHC jobs is like across the province but there are many positions outside Toronto. I wouldn't be surprised if the job market was good for CHC positions. The patient population isn't enjoyable for many physicians. 

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5 hours ago, blah1234 said:

Last I talked with my friends I heard that there are CHC spots that have difficulty filling. Not sure what the distribution of CHC jobs is like across the province but there are many positions outside Toronto. I wouldn't be surprised if the job market was good for CHC positions. The patient population isn't enjoyable for many physicians. 

People make it sound like regular family medicine offices dont also take on some of these patients. Not all regular fee for service GPs cherry pick patients. Ive been in numerous offices where we have to spend time with patients with mostly social issues. It just means they take a hammering on them billing wise and have to make it up with quicker refill type appts with other patients.

Obviously not universal though. But CHCs just add the element of not having to worry as much and the privileges of time. 

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On the related topic of FM in Ontario, can practicing GPs/or newly practicing FM grads comment on the practice environment in ON? I have heard from numerous in-practice sources that (in some part due to the fee cuts) it is not unusual to see 40-50 patients/day (meaning an average of 8-12 mins per appointment - assuming 8 clinic hours). I'm left wondering if it is possible to fulfill all expectations of patient care/college regulations in that amount of time, particularly if this pace continues day-in and day-out.

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1 hour ago, loremipsum said:

On the related topic of FM in Ontario, can practicing GPs/or newly practicing FM grads comment on the practice environment in ON? I have heard from numerous in-practice sources that (in some part due to the fee cuts) it is not unusual to see 40-50 patients/day (meaning an average of 8-12 mins per appointment - assuming 8 clinic hours). I'm left wondering if it is possible to fulfill all expectations of patient care/college regulations in that amount of time, particularly if this pace continues day-in and day-out.

As a new grad you're going to be finding it hard to see that # of patients in a day, especially with associated paper work and such.  As time goes on and you get more regular patients with chronic problems, more feasible as you know them and can spread things out over multiple appts. i.e. refills etc

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1 hour ago, JohnGrisham said:

As a new grad you're going to be finding it hard to see that # of patients in a day, especially with associated paper work and such.  As time goes on and you get more regular patients with chronic problems, more feasible as you know them and can spread things out over multiple appts. i.e. refills etc

As mentioned above, it is possible to do so, but IMO I'd never want to actually see ++ pts per day. FM clinic is quite monotonous. Hats off to those who can stomach it and not dread going in everyday.

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10 hours ago, freewheeler said:

As mentioned above, it is possible to do so, but IMO I'd never want to actually see ++ pts per day. FM clinic is quite monotonous. Hats off to those who can stomach it and not dread going in everyday.

Well when many of those patients are only brining in 30-36$ a pop, you're somewhat motivated to see more otherwise you're making 23$ a visit after overhead sometimes. 

Hence why some prefer the fixed hourly APPs. Pay me 150$/hr for 4 hours gauranteed regardless of the # of patients you see, and not have to stress about seeing 5 patients that hour to equal out that hourly. 

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40 minutes ago, JohnGrisham said:

Well when many of those patients are only brining in 30-36$ a pop, you're somewhat motivated to see more otherwise you're making 23$ a visit after overhead sometimes. 

Hence why some prefer the fixed hourly APPs. Pay me 150$/hr for 4 hours gauranteed regardless of the # of patients you see, and not have to stress about seeing 5 patients that hour to equal out that hourly. 

Yeah. I find the variety of presentations to FM clinic to make standardising workflow relatively difficult as well. Oftentimes patients book for one issue but something else more medically pressing may arise.

Really for myself I don't think FM would be a sustainable career choice. There are a lot of expectations on family physicians and with comparatively poor remuneration that has you running between examination rooms day in and day out, I would hate to be looking toward a multi-decade career in that.

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On 12/29/2018 at 1:03 PM, freewheeler said:

Yeah. I find the variety of presentations to FM clinic to make standardising workflow relatively difficult as well. Oftentimes patients book for one issue but something else more medically pressing may arise.

Really for myself I don't think FM would be a sustainable career choice. There are a lot of expectations on family physicians and with comparatively poor remuneration that has you running between examination rooms day in and day out, I would hate to be looking toward a multi-decade career in that.

I agree. The better remuneration option is through FHO & FHT, where you are paid per capita for enrolled patient, but the Ontario government has realized that it costs $$$ money for same amount of patients seen (given complexity of patients ), and are counting down on the new grads entering FHO & FHTs. 

Overall, I still find family medicine very rewarding with continuity of care, also it has a great job market and allows life-work balance. As a resident, I already get a few job offers (not just locums), and it's definitely up to you on where and HOW you want to work, you could specialize in one field or do exclusively in-patient work, and switch back later to out-office practice once you are tired of long hours.

I don't know many FRCPC specialties (except perhaps psychiatry and general pediatrics (becomes even too saturated in GTA where many just do primary care pediatrics?!)) , that have a great job market. After seeing a few specialty friends sub-specialize with no clear goal and locuming a few shifts per month as they are geographically bound, I think that Family Medicine is a great specialty.

I do agree that family physicians are relatively less remunerated given the number of hours you spend after office hours for critical results follow-up, writing notes, referrals; and the amount of responsibility you have to carry as patient's MRP; but nothing is perfect and every specialty has its up and downs.

Just my two cents :)

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